Work on this project has documented the prevalence, severity and impact of pain in patients with cancer. A consistent theme has been the refinement of measures of cancer pain, its impact, and treatment. More recent work has focused on the under-treatment of cancer pain, conceptualized as barriers to adequate pain management. These barriers include health professional attitudes and treatment knowledge, patient reluctance to report pain and comply with analgesics, and problems with the health care delivery system. The research goals of this funding period focus on barriers to adequate care and possible interventions to reduce their impact: (1) The role of patient-related factors in under-reporting cancer pain and in not obtaining pain relief will be examined, (2) An instrument to describe typical physician practice of cancer pain management will be developed, and used to contrast styles of pain management with the recommendations of an expert panel, (3) The effects of different cultural and linguistic group membership on pain report will be evaluated, (4) The first-time use of potent analgesics in patients with moderate to severe pain will be studied, (5) The effects of patient and public education on attitudes toward cancer pain and its treatment, and on treatment outcome variables will be evaluated, (6) The use of standardized criteria for treatment outcome studies will be explored, and, (7) Methods for cost/benefit analysis of cancer pain treatment will be developed. The scope of these studies has been expanded by liaisons with the Wisconsin Cancer Pain Initiative, the World Health Organization, and the Eastern Cooperative Oncology Group.